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10/22/09 5:10 PM Defining Medical Wants and Needs: Dana- lesbian, doesn?t want to bear a child, wants a breast enhancement. Steve- 2 month old whose parents want CDC-rec vaccinations Jan- a 12 yr old whose parents want a well-child visit (basic check-up) and growth hormones. Tim Tebow- shattered left ankle and wants surgery. Norman Daniels, ? Is There a Right to Health Care and, If So, What Does It Encompass?? In this essay, Daniels was concerned with the context of an ?advanced industrial democracy,? such as the United States, Great Britain, Canada, the Netherlands, etc. He asked whether there is a moral/legal right to healthcare for citizens of such democracies. Positive Right- requires others to ?do something beneficial or enabling for right-bearers? (47) (e.g. education, food, sufficient income.) If there is a right to healthcare, it must be a positive right. Negative Right- ?requires others to refrain from doing something, usually harmful or restrictive, to right-bearers? (47) (e.g. speech, vote, religion). In a democratic society, it is the responsibility of the government to provide for our positive rights and to protect our negative rights, whatever these rights might be. Next, Daniels discussed three theories of justice. Each of these theories reaches a different conclusion for the question in the title of this essay. (So, forget about what the U.S. or any other democracy, in fact, does, each of these theories attempts to tell us what we should do. A. Libertarianism According to libertarians, people are roughly equal in our capacities to succeed in a democratic society by setting goals for ourselves and using our ?freedom? and ?personal aspects? to pursue those goals. Thus, because people are roughly equal in this way, we should be help responsible for the was in which we use or misuse our freedom and personal assets. Our rights to ?freedom? and our ?personal assets? are our most fundamental rights (i.e. these are rights that should never be violated). Our ?personal assets? include property, money, talents and skills. Our ?freedom? involves using our bodies and personal assets however we would like to use them, just as long as we do not violate the freedom or personal assets of others without their consent. According to libertarians, there is no right to health care. If the government were to ensure that all citizens receive health care, the fundamental rights of some of those citizens would be violated because (a) some citizens would pay for that health care (through taxes) without their consent, and or (b) some citizens would be required to provide health care without their consent. Both (a) and (b) would be violations of one?s ?fundamental rights?. So, according to libertarians, if anyone receives healthcare, how will they receive it? They must either (a) pay for it in a free exchange with health care providers or (b) receive health care for free through the charity of others. Yet, (b) is not a right, so no one (neither individuals nor the government) have an obligation to ensure that all who need health care receive it. Libertarians rely on the ?free market? to distribute health care goods/services. B. Utilitarianism According to utilitarian?s, people are roughly equal in our capacities to experience pleasure and suffering. For Utilitarian?s, the fundamental value is ?utility? (i.e. pleasure and or the absence of suffering). Recall that, according to Rule Utilitarian?s, one of the goals of moral and legal thinking is to specify rules that, when obeyed, will yield ?the greatest good for the greatest number of people.? So, for Rule Utilitarian?s, the question is: For this democratic society, what rule re the distribution of healthcare goods/services would maximize utility? If the answer is ?a rule that distribution of some healthcare goods/services to some/all citizens,? then, for some/all citizens, there is a right to healthcare. Now, Utilitarian?s agree that, as an empirical fact, a person?s access to healthcare tends to increase utility, and that person?s lack of access to healthcare tends to decrease utility. Yet, for Utilitarian?s, there remain two controversial questions: 1. Are there other goods/services that society should distribute instead of healthcare because those goods/services will produce more utility than would the distribution of any healthcare? If the answer to (1) is YES, then the Utilitarian reaches the same conclusion as does the libertarian, i.e. there is no right to healthcare. If the answer to (1) is NO, then the utilitarian must specify (a) how much health care should be distributed and (b) when it should be distributed. (a) is concerned with the kinds of healthcare that should be distributed to maximize utility (i.e. preventative care, primary care, specialty care, prescription drugs, assisted-living care, long-term home/nursing care, etc). In other words, some Utilitarian?s ask: What kinds of healthcare will generate the highest ration of benefit cost? MAXIMIZE UTILITY?MINIMIZE SUFFERING (b) is concerned with the phases/stages of human life during which healthcare should or should not be provided. Perhaps there are phases/stages of life that are not worth an investment of healthcare goods/services because such an investment would have a very low benefit-cost ratio. Bioethics 10/22/09 5:10 PM 10/22/09 5:10 PM

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